Unravelling

She sat at my kitchen table with her foot resting on the chair and her knee pulled up to her chin.  Her blond hair perfectly placed in a messy bun, juxtaposed against my un-purposed messy morning hair.  We planned a coffee date for first thing in the morning, after she dropped her kids off at daycare.  We picked my house because the baby likes to sleep late.  She had a lunch date with another friend later that day: she was trying to fit in as many visits as she could.

“What can I get you to drink?” I asked as I instinctively placed a mug under the coffee maker. “Coffee?”
“No thanks, just water,” She replied. “I’m changing the way I eat.  No coffee, nothing processed.  I want to make my body as strong as I can.  I’m getting ready to fight this.”
I wasn’t sure if she wanted to talk about it.  I said I was going to take her lead.

We met the year before at Taekwondo.  Her oldest son was in my youngest son’s class.  For weeks we would sit and talk about the superficial realities of life: Work, kids, husbands, weather… Slowly, our friendship developed and we would occasionally meet up outside of the gym.  I’m always happy to make new friends.

“So, when did this all start?”
“Remember back in February, when I had pneumonia?”

She was gone for weeks from Taekwondo, I remembered.  She came back and it seemed to take ages for her to fully recover.  When the snow started to melt, I ran into her in the neighborhood, walking with her husband and two boys – it was the first time I had ever met her younger son, who wasn’t more than three.  We vowed to have a playdate with the kids once the weather was a little nicer.

“The chest pain never went away, so they did an x-ray and they found two spots.  I had a biopsy.  Then I had a CT scan.  Then they wanted a PET scan.”
I listened intently, trying not to ask too many questions.

A few months ago we all went out together for a friend’s birthday party.  Our friend was turning 33.  Just like me… and just like her.  We joked that 33 would be the best year; it had to definitely be better than 32! And we toasted to that, them with their wine glasses and me with my diet pepsi (since I was pregnant and all).  We vowed to have more get-togethers after that – but we didn’t

“They found a few spots in my hip bones and in my leg bones.  I’m going for my first appointment with the oncologist on Wednesday.”

Wednesday was my birthday.  There would be not be another toast to 33 on my birthday.  No this time.

“I’m going to tell her that I don’t want timelines and I don’t want numbers.  I’m going to beat this.  I know I will!”

I painted a reassuring smile on my face and placed my hand over hers.
“Of course.”

I waited until she left to feel the sadness and the heartache – for her and for me.

I don’t think I could ever be so strong if I was diagnosed with Stage 4 Lung Cancer.

 

The Real Struggle

I woke up this morning feeling like today would be a struggle.  I have these days every so often, and it is always the same thoughts and issues that plague me.  I feel lost and lonely – like I haven’t navigated my way through life very well at all.

I am days-to-weeks away from having a third baby.  For this whole pregnancy, and even the months leading up to it, I have questioned whether this is a reasonable step to take in my life.  I obviously can’t go back and change things now, but it doesn’t make me feel any less stressed about how everything is going to fit together in the coming years.

I know I should be looking forward to my maternity leave, and I *kind of* am.  But I am nervous about what I’m going to do with all that time at home!  I know I’ll be taking care of my baby and for the first weeks I will be so exhausted that I won’t know night from day (can you tell I’m looking forward to this?), but sometimes I find that my home is not the peaceful, relaxing place where I imagine spending my down time.  There is so much to be done around my house: teach my nanny how to cook, deal with the clutter that has accumulated over the time that I’ve been neglecting housework (and letting my nanny do a sub-parr job of keeping up), figure out how to discipline my children, decide if I need to hire a new nanny (since the one I have seems to have difficulty with all the above things that I have to remediate)… That just part of the home list.

Then there is my anxiety about work.  Failing my exam has certainly not made me feel any better about my position and my performance at work.  I know that I likely didn’t prioritize studying as much as I would have it I actually had to pass the exam.  However, I feel like it reflects poorly on my ability to balance my work like and my home life, and in the coming weeks that struggle is only going to get worse.  Add in the fact that I am going to be taking 5 months off work and will be that much behind – I feel like I am going to have a target on my back, setting me out as “the weak one.” Any why am I the weak one?  Because I have kids and a family, and I can’t make my work my top priority all the time – especially when something in my work world doesn’t really matter (like a test that I don’t need to pass).

I struggle with finding people to connect with in my life.  All of my good mommy-in-medicine friends are back in the place I left behind when I moved here for residency.  I have yet to find some good friends here.  I marginally succeeded in finding some out-of-work friends, but since work has gotten so much busier in the last year, those relationships haven’t been well maintained.  Not to mention, I can’t really talk about most of my difficult struggles with them… I mean, when someone tells you they had a bad day because their kid’s school bus was late so they missed their aerobics class, how do you respond when your bad day was doing a STAT c-section on a full-term baby who didn’t survive?  And there is the opposite situation with friends from work.  All my co-residents are wonderful people, but most of them don’t have kids and that makes it very difficult to commiserate with them.  Who can I talk to about my feelings of inadequacy as a mother, or about my decisions to prioritize my life differently because my kids and my family are an important (arguably the MOST important) part of my life.  Mostly, I feel like this position is a very lonely place to be and I don’t know how to make it better.

I’m sure that in a few days I will be feeling better than I am today.  For today, though, I have to push through the discomfort of the struggle.

 

Pregnant at Work

“Oh wow, look at you! How many weeks are you now?””30 weeks already!? It sure is going by fast! How much longer are you planning to work?”

Indications: This 36 year old G3P2 woman was admitted to hospital with a history of a missed first trimester abortion. She was referred to our care after a community ultrasound performed on [date] at 17 weeks 5 days gestational age revealed a fetus measuring 11 weeks 6 days with no fetal heart rate activity. She was recommended to have a D&C by aspiration. The risks of the procedure, including infection, bleeding, and uterine perforation with injury to adjacent pelvic viscera were discussed with the patient, along with the benefits, and she gave informed consent.

“You’re having a girl!?! Oh, I didn’t know that! What do you have at home again? 2 Boys – oh, you must be so excited!”

“You must be getting tired now, with all these hours that you work. Are you done call now?”

Procedure: The patient was taken to the operating room and received a general anesthetic by Dr. X. She was placed in the dorsal lithotomy position and prepped and draped in the usual manner. Examination under anesthesia revealed a 13 week sized uterus and no palpable adnexal masses.
“Well, you look great! It is your third after all, everyone looks a little bigger the third time around.”

“I had a boy and two girls, and let me tell you, it was the time of my life! This time will go by so fast!”

A weighted speculum was placed into the vagina and the anterior lip of the cervix was grasped with a double toothed tenaculum. The uterus was sounded to a depth of 16cm. The cervix was dilated without difficulty to accommodate a size 14 suction curette. We then proceeded with the suction curettage. Tissue was obtained and sent to pathology. We then proceeded with a gentle blunt curettage and no tissue remained.

“Are you all ready at home yet? Oh, the boys must be excited to share a room, no?”

“They must be thrilled to be having a baby sister! Do they understand what’s going on? Maybe they’re still too young yet…”

The patient tolerated the procedure well and was returned to the recovery room in stable condition. Estimated blood loss was 100cc and there were no apparent complications. The patient is requested to follow up with her practitioner in 6 weeks time.



“I don’t think they’re too young, they know exactly what’s going on… for sure.”

“I should get going and eat some lunch, you never know what the afternoon will bring.”

And, so I walked briskly out the of the recovery room.

End of dictation.

Distressing Dreams

The past has been coming back to haunt me.

Over the past few weeks I have been having a series of distressing and upsetting dreams about people and events from the past.  I have spent an inordinate amount of time trying to process and accept the misfortunes that serve as the basis for these dreams, but clearly, they are still stirring around in my subconscious, waiting to haunt me at the least opportune times.

It is coming up on that time of year again: the residency matching saga where medical students scramble to apply to, interview, and eventually get offered (hopefully) a residency position where they want.  If you followed my old blog, you will know how distressing of a time this is for me.  If you are new to my blog, I’m sorry that this post will make less sense to you – I will try to find a way to explain the terror that this time of year was for me when I went through it a few years back (perhaps in another blog post).

Intertwined in the match saga is the surge and then eventual demise of my relationship with my old friend and mentor, Kay.

Unfortunately the dreams that have been occurring lately have all involved Kay or other people that elicit the painful and undesirable memories that this time of year holds for me.  I know that my current levels of dissatisfaction and confusion about my career choices makes these memories and events even more difficult to tolerate.  After all, if I was very happy in my current situation it would be easy to say that “this was the best thing that could have happened to me.”  But, I can’t say that.  So, my subconscious continues to dwell on the “what if” and “if only” byproducts of my past misfortunes.

One dream that is recurrent, but seems to be more prominent now, involves the resurgence and reconnection of my friendship with Kay.  It plays out exactly how I wish it would have long ago.  It is a beautiful dream filled with honesty, forgiveness, understanding, and starting anew.  However, too much time has passed now and having this dream only causes pain because I know it will never come to be.  I end up asking myself why I still dream of having her back in my life as a valued friend, after everything that’s happened.  I want to believe that she is a good person who either did what she needed to do at the time, or realized she made a mistake with how she treated me.  Unfortunately, as more time passes, I come to believe more and more that she feels that she made the right decision by removing me from her life.

I have “recollection dreams” about how important Kay was at this time in my life, those few years ago.  I recall her supportive words and her sympathy and empathy over the catastrophic events.  I re-experience all the good and wonderful times we had in our friendship and I wake up to the sorrow of knowing that something so wonderful no longer exists.  And to make it worse, that sorrow is filled with feelings of guilt and anger towards myself – reminding me that I am at fault for the absence of this beauty in my life.

Last night my sleep was riddled with variations of the same dream: This one involved interactions and observations of the people who didn’t experience my same misfortunes.  These people are, in essence, living the career life that I had imagined for myself… The life that was shattered for me with little explanation, but that was given to them as they expected.  I watched them as they expressed satisfaction and happiness with where their lives are going, all while I am lost in the confusion and distress of my own life.  The variations involved them coming into my world, and me going into their world, and regardless of where we were, I felt resentment and anger towards them and the system that allowed this to happen.

It is not helpful for me to experience these types of dreams while I am in the midst of trying to overcome negativity in my day to day life.  It is difficult for me to get out of bed after a night of distressing dreams and say to myself, “today is going to be a great day!”  It is next to impossible to keep looking forward and push through my day -to-day challenges when my subconscious continues to drag my back into the past I am trying to overcome.  I can’t control what I think about when I sleep, and I have no solution to overcome this problem.

Late Termination

1.
I punched the 5 digit number into the phone and waited for someone to answer… “Hi, this is the gyne resident, you paged?”

“Yes.  The induction is here. Can you please come and write orders and get things started?”
I wasn’t aware of any induction, nor was I in the right frame of mind to initiate an induction.  Where I live, “late terminations” by induction of labour can be performed for lethal or life threatening fetal anomalies up to 24 weeks.

I went to the ward where the patient waited for me.  She was likely not expecting the person about to initiate her induction to be just as pregnant as herself.  Her chart was clear – her due date only 2 days before mine.  Her unborn baby the same size as mine… moving and kicking and full of life, just the same as the one inside of me.  The only difference: my baby had a normal heart, and normal kidneys, and a normal bowel.  Hers did not.

I went into the room to find her laying still on the bed.  I hoped my scrubs were loose enough to disguise my swollen belly, even though I knew it wasn’t likely.  I explained to her the procedure – how I was going to giver her some medication that would make her cervix soft, and that I would put a small balloon inside her cervix to help it open up.  Essentially I would be inducing her labour, and then she would give birth to a pre-viable fetus that would not survive.  My baby in.  Her baby out.

I sat on the cold, metal stool between her trembling, spread out legs.  I placed the speculum and opened to find her swollen, closed cervix.  “You might feel some cramping now,” I said as I slid the catheter into the opening.  I began filling the balloon.  She winced.  Bright blood started to trickle from the end of the catheter.  I slid the speculum out and placed the medication in its place.  “We’re done.”
I felt my own baby kick me from the inside.

2.
It was 5pm and my night shift was just getting started with handover.  “The woman in room 6, she’s  an indiction for cardiac anomalies.”  I cringed.  It had been less than a week since the last induction.  I didn’t think I could handle another one so close.  “The patient and her partner are not coping well, just so you know.”
This time the baby was already gone – the family had chosen an intracardiac injection prior to induction.  This time her due date was the same as mine.

I decided not to meet the patient – unless there was a medical issue that needed attending, there was no need for me to go in.  I hoped that it would be a slow process and that I could get through the night without being called to see her or her stillborn baby over the next 14 hours.  It almost came to be.
But 30 minute before the end of my shift the nurse called me: “I’m really sorry, but her foley came out and Dr. X called and wants you to break her water.”  It would have been “inconsiderate” for me to leave that task for the person coming on after me.  So I went.

Again, I was too conscious of my own pregnant belly – of my own live, healthy baby who is perfect and who is still alive.  I pulled the scrub gown I was wearing backwards around and over my swollen-ness.  I introduced myself with trepidatious confidence and then sat at the end of her bed.  I proceeded to do what I do so often for women in labour with babies that they are going to bring home with them.  I felt her cervix and stretched it open.  With elegant ease I slid the hook up against my fingers until it reached the tough, premature membranes.  I felt sick at the thought of my hand being so close to a dead baby, the same size as mine.  I almost said that I wasn’t able to reach, even though I could.

I tore the membranes apart and watched as the clear, straw coloured fluid poured from her body.  Suddenly my fingers felt vast space and openness.  I felt my heart skip a beat as I was unable to tell if her cervix fell from my grip and I was feeling her vagina fill with fluid, or if her cervix was suddenly wide open and at any moment I would catch her baby with my fingers and deliver it right at that moment.  The water seemed to gush forever and my hand was paralyzed in place.  I feared that I would feel the delicate touch of her baby’s hands or feet or head and I wanted that moment to be over.  When I could no longer handle the thought of delivering a stillborn baby the same age as mine, I pulled my hand out and tried hard to stand without fainting.

It was the end of my shift.  I went home to sleep.  I woke up hours later and decided that I was done doing late terminations as long as I am still pregnant.

I Almost Forgot

“You cannot protect yourself from sadness without protecting yourself from happiness.”
~Johnathan Safran Foer

I almost forgot that this day, November 27, used to be meaningful to me.  On this day, I guess 6 years ago now, I met the person who became one of my closest friends for a short time.  Last year I was sort of “celebrating” this milestone.  But up until I re-read the post from this day last year, I ha forgotten the importance of this date.

I admired her so much.  She embodied everything I thought I wanted to have in a role model and a friend.  She embodied everything I thought I wanted to be.  We became good friends for a short while, but then she pulled away.  I was hurt so badly.  Sometimes I still miss her, but most times I wish I could just stop thinking about her.  I catch myself wondering if there is still a “what if?” But then I bring myself back to reality.

I let myself be happy for a brief time by taking risks, living authentically, and being vulnerable.  Unfortunately, this happiness didn’t last and the loss of that friendship caused me a great amount of sadness.  The question then becomes, what that brief moment of happiness worth the sadness?  It is really hard to know for sure.

My Backstory

“We are all special cases.”
~Albert Camus

From The Old Blog, November 21, 2014

We all have a story that makes us who we are.  I would argue that these stories are not always fun to tell or easy to accept.  It is these stories, however, that make us “special.”  My story is far from great, but I know it could have been worse.  I am the grown up child of a messy divorce, and this simple fact has made the “special case” that I am today:

My parents were newly divorced and were too busy hating each other and making each other miserable to really realize what they were doing to their children.  They provided the necessities and we never wanted for anything physical – we were clothed and fed, we went to school and we did well.  Emotionally, they gave us nothing.  I never felt special or like I mattered to my parents.  My accomplishments always seemed to fall on deaf ears and land in front of blind eyes.  I was a 12 year old girl with nothing to motivate me and no one to encourage me.
~From The Old Blog

Some days I go back to being that 12 year old girl, and I get angry at myself every time I do it.  I am embarrassed that this so heavily defines who I am and how I interact with people.  I fear that I will never be able to escape from that 12 year old me.  And, that right there is the problem: I should not want to escape from her.  Rather, I should want to open up my arms to her and give her that which she never had.  I should be the one to support her, motivate her, cheer her along, giver her advice, and be her best friend.  That is exactly what she has spent the last 20 years trying to find.  Now I can be that for her, I just need to believe it.

We all have stories that make us special cases but many of us are too afraid to go back and read those stories.  Those stories are what make up who we are and we need to understand them to really understand ourselves.  Going back to the beginning can also tell us how far we’ve come and, hopefully, allow us to realize how much we can help ourselves.

I an not a special case because I am the grown up child of divorced parents.  I am a special case because of what I have become as a result:
I am sensitive, kind, and loving.
I work hard, seek perfection, and achieve my goals.
I put others before myself and passionately give everything I can.
I am a loving mom, a sincere wife, and a good friend.

I am all of those things, even if I don’t always believe it… even if other people don’t always believe it.

Sense Out of Sense

“Hope is definitely not the same thing as optimism.  It’s not the conviction that something will turn out well, but the certainty that something makes sense, regardless of how it turns out.”
~Václav Havel

 

It seems as though this quotation didn’t fit with my mindset last year, and it certainly doesn’t fit with how I am feeling now, either.  Or maybe, if I look at it from a different angle, it does make sense.

A few days ago I wrote a post about hope being a song that we sing in the depth of our being – something that never stops no matter what.  Right now I am tired and overworked and I feel like hope is the only thing I have – I hope that I get through all of this and that it will be worth it in the end.

Does that make sense?  I don’t know.  Maybe according to this quotation, it is supposed to makes sense.  Whether or not all of this hard work pays of in the end… hmm… I’m not sure if it makes sense for it to not turn out.  That would be a whole lot of “nonsense.”

The other day I met with one of the staff to go over my evaluations from a few months ago: For July and August.  Apparently everyone only had good things to say about me: I am hard working, I have good surgical skills, I work well under pressure, I don’t get stressed out, I make good assessments and plans, I know my limits, I don’t get bogged down in the minute details… but there was one thing that seemed to concern people – they were worried that I seemed unhappy.  I didn’t know what to make of that comment, or what to do with it.

I’m happy, but I’m not happy.  It’s hard to always be smiling and cheerful when you are tired and wondering if you’ve made all the right decisions in life.  Or more vaguely stated, when you’re not sure if everything in your life makes sense.  So what do I take away from that feedback session?  I should be happier when I’m at work, maybe?  Obviously I know that these last few months haven’t been easy for me, and there is a reason I see a psychologist on a regular basis.  Overall, I didn’t know what to say.  I enlightened her on the whole “people at work found my blog and I was criticized and harassed online because of it and everyone at work was talking about it behind my back” situation that happened in the middle of July.  I told her how I completely shut down at that point because I didn’t know who I could trust to talk to about anything, even something as simple as a night with my kids.  Maybe that contributed to it… I don’t know.  Or maybe it’s just my personality… maybe that’s it!

Regardless, nothing ever makes sense.  I feel like I am blindly floating around with the hope that in the end everything will fall into place… some kind of place.

The Story of Ms. Jones

“Life isn’t fair.
It’s just fairer than death,
That’s all.”
~William Goldman

We were about to round on Ms. Jones (not her real name).  I admitted her the other night after she fell and was found in her bathroom by the aides at her assisted living complex.  She was lucky: she didn’t break any bones despite the grapefruit sized hematoma that was forming over her left hip.  I learned from the emergency room chart that she was a relatively healthy 95 year old lady with a history only significant for hypertension and atrial fibrillation.  I tried to go talk to her and do a physical exam, but she was grumpy and drowsy and wouldn’t cooperate (in her defence, it was maybe 3am and the emergency physician had just given her some dilaudid).  I filled out all her admission paperwork and scanned her home medication list.  I opted to continue her medications for hypertension and her aspirin, but since her hemoglobin had dropped during her stay in the emergency room from 108 to 86, I thought it prudent to hold her anticoagulant (blood thinner).

When we walked into the room that morning, I was pleasantly surprised to see a well groomed, alert, and very proper English woman sitting up in bed and eating her breakfast.
“Good Morning Ms. Jones,” my staff said.  “We are your team of doctors and we are here to see how you are doing.”
“Well, if you want to know about my pain, it is okay.  But if you want to know how I’m doing, well I’m rather upset that the nurses won’t give me any hot water for my tea.”

It turns out there was a communication error and the nursing team believed that Ms. Jones was on a thickened fluid diet to minimize the risk of lung aspiration.  As this diet is quite common in our patients, we continued to explain to Ms. Jones the rational behind why she wasn’t allowed to drink her tea.
“Well, that just ridiculous!  I was just drinking tea the other day and I certainly didn’t choke on it.  I don’t see why it is any different today.”
We offered to place Ms. Jones on an “at risk diet” if she insisted on drinking her tea.
“Well doctors, I am 93 years old.  What do I have left in my life if I don’t take risks?”

She had a point, I guess.  We proceeded with our rounds, ordered the necessary tests and continued on with the day.  We thought about re-starting Ms. Jones’ anticoagulation, but her hemoglobin was down to 80, so we held off and sent her for a CT scan instead.  The results came in later that day and there were no identified areas of internal bleeding.  We decided we were going to restart the medication the next day.

When we rounded the next day, we visited Ms. Jones again.  She was happily eating her breakfast and drinking her tea.  She complained that she had been feeling increasingly weak over the past month and attributed her fall to that weakness.  She commented that it was just part of getting old.  Regardless, we asked for a physiotherapist to help Ms. Jones with her mobility and assess if she needed any aids.  As planned, I wrote an order in the chart to re-start the anticoagulation.  It was all ready to go, but we all suddenly felt uncertain: She had only been off of it for 3 days.  Why not wait one more day and make sure her hemoglobin remains stable?  It is a delicate balance trying to decide how to manage these medications for a person with atrial fibrillation who is also at a high risk of bleeding.  Without the medications, there is a chance that the heart can throw off blood clots that can cause a stroke.  With the medications, however, it becomes difficult to control andy sources of bleeding.
Later that afternoon, I passed by Ms. Jones walking with the physiotherapist and a walker down the halls of the unit.  She smiled at me, and I smiled back.

The next day was Friday and we started rounds in the same way we always do.  Our team was a little smaller, so we divided up the work and moved a little faster so that everything would get done.  We got to Ms. Jones’ chart.  The physiotherapist was convinced that she would safely mobilize with a walker.  Her hemoglobin had been stable over the past 36 hours, and from all other aspects, it seemed like she was ready to go home.  We walked into her room to tell her the good news.  However, Ms. Jones was not sitting up in her bed eating her breakfast.  Instead, she was laying with her head cocked to her left side, her right leg flexed and rotated to the left, and her right arm motionless by her side.  We said hi to her but all she did was moan.
“Ms. Jones, are you alright this morning?”
She just moaned again, this time louder and more persistently.  I went to her left side and looked at her.  She wanted to say something, but all she could do was moan.  She reached for the ID badge dangling from my neck and looked at it.  Then she looked at me.  And she moaned again.  My staff had already left the room and was on the phone with a radiologist requesting a STAT CT scan.  But we didn’t really need it to know that Ms. Jones had a stroke, likely sometime overnight.

By the time Ms. Jones’ sons had arrived at the hospital, the results of her CT scan were back: Large right MCA territory infarct.
We explained to her sons what this meant and that given her age and the size of the stoke, she likely had a poor prognosis.  We explained the options for her further care and it didn’t take long for them to both agree that their mother would not be happy living the way she was now.  The felt that if their mother could talk to them, she would say that it was her time to go.

And just like that, we consulted palliative care for Ms. Jones.  We discontinued all her therapeutic medications, and ordered all our comfort care measures.  She was moved to a private room.  And ever since that day, there has been a constant bedside companion from her family present.  I know this because I visit Ms. Jones multiple times a day.  She knows who I am and she smiles at me when I tell her that I’ve been thinking about her.  Every day she looks more and more like it might be her last day.  But every morning her name is still on my list.  So I go back to visit her again.

It was the day we were going to send her home, and instead it became the day that determined her death.  It isn’t fair.
Ms. Jones was such a fun. happy, feisty little English lady who probably had a few more good years ahed of her.  But our medical care failed her and now she is dying.  Life isn’t fair.
Every day she slips further and further away.  She spends less time awake and I spend more time talking with her family members.  They tell me stories about their mom and it makes them happy.  Then they turn at look at their dying mother asleep in her death bed, and their voices stop.  I let them cry and I place my hand on their shoulder for just the right amount of time.  Death is not fair.

I decided to share last year’s blog post in it’s entirety.  The remains poignant and I still think of Ms. Jones, to this day.

Bad Mommy

After working a long call shift with absolutely no sleep, I was relieved to finally go home and meet up with my blanket and pillow. I was home so early that the kids were just getting ready. Little A was jumping around and excited that I was home: “Mommy!  You’re home!  Are you going to take me to the bus stop?”

I sat down with him to try and explain that mommy had been awake the whole time that he was sleeping. “I’m so tired honey, and I really need to go to sleep. Your bus doesn’t come for another 45 minutes and I can’t stay awake that much more.”

His disappointed voice trailed off as he jumped down from my lap and proceeded to dress himself. “Mommy, I just really wanted you to walk me to the bus stop.  But it’s okay, I guess, because today we are going on a filed trip to the science centre!”

He had been talking about this field trip for the past week with so much excitement. It doesn’t matter that we have passes to the science centre and go fairly regularly, because this time he is going with his school friends. “That’s right, honey!  You have a fun day today, okay!”

I got into my bed and promptly fell asleep. I awoke hours later and lolled through the list of emails on my phone. I was still not rested enough, but knew that if I didn’t wake up then, I wouldn’t get back to sleep later that night. There was one email that caught my attention – it was from A’s educational assistant. She only emails me when there is something she needs to tell me about issues at school:

 “I wanted to email you and let you know that A. was not able to go on the field trip today because his permission form was not signed. He was very upset and I explained to him that there is other field trips coming up that he will be able to take part in. I stayed with him at school and once he was calmed and feeling better we joined the English kindergarten class and he had a good morning.”

I almost started to cry after reading this. I signed an “all encompassing field trip permission form” the week prior and sent it back to school. I remembered that on Friday they sent a revised form home because something had changed on one of the field trips in the future. That form sat on Twitter kitche counter all weekend and I forgot to sign it and send it back. Apparently the school tried to call me, but they claimed to not have a current phone number for me. I was so angry at the school, but I was more angry at myself. 

Before I got out of bed I had visions of my poor little A. Crying at school and not understanding why everyone else was getting on the school bus to go to the science centre and he had to stay behind. I imagined his disappointment, his anger, his helplessness, and his resignation. I then started to cry. 

I slowly got out of bed and opened my bedroom door. It didn’t take more than 10 seconds for little A. To come running into my bedroom: “Mommy, today was a horrible day at school, do you want to know why?”  I let him tell me all about his sad day, even though I already knew about it. And, I quickly relived the pain I caused him over again. 

I fear that these are the things in life that kids never forget. He doesn’t understand that it was my fault that the form wasn’t signed, but that doesn’t make it any better. He will always remember how it felt to stay behind when everyone else got to go.